Topiramate (Topamax)
Generic Name: Topiramate
Brand Names: Topamax, Trokendi XR, Qudexy XR
Drug Class: Anti-seizure medication (multiple mechanisms)
Primary Uses: Focal seizures, generalized seizures, Lennox-Gastaut syndrome
Common Side Effects: Drowsiness, appetite loss, concentration difficulty, tingling, decreased sweating
What is Topiramate?
Topiramate is an anti-seizure medication used to treat various seizure types in children and adults. It has been used successfully for many years and can be effective for difficult-to-control seizures.
How It Works
Topiramate works through multiple mechanisms in the brain to help prevent seizures. It affects sodium channels, enhances certain calming signals, and reduces excitatory activity that can lead to seizures.
Who Might Take This Medication?
Topiramate is FDA-approved for:
- Focal (partial) seizures in adults and children 2 years and older
- Primary generalized tonic-clonic seizures in adults and children 2 years and older
- Lennox-Gastaut syndrome in adults and children 2 years and older
It is also sometimes used off-label for other seizure types under medical supervision.
Common Side Effects
Some children may experience one or more of the following side effects. These should go away as your child’s body gets used to the drug. Discuss the side effects with your doctor if they continue:
- Drowsiness
- Nausea
- Loss of appetite
- Unable to concentrate
- Decreased sweating ability which may increase body temperature (fever), especially in hot weather or with exercise
- Tingling in the hands and feet (paresthesias)
Topiramate can decrease your child’s ability to sweat, which may cause body temperature to rise. This is especially important in hot weather or during exercise. Make sure your child:
- Drinks plenty of fluids to stay well hydrated
- Avoids overheating in hot weather
- Takes breaks during physical activity
- Watches for signs of overheating (flushed skin, fever, dizziness)
When to Contact Your Doctor
You should be seen by a medical professional if any of the following develop:
- Weight loss
- Decrease in urination and/or blood in urine (may be a sign of kidney stones)
- Discomfort or back pain (may be a sign of kidney stones)
- Mood changes (feelings of depression, suicidal thoughts, anxiety, or panic attacks)
Eye Problems - Seek Immediate Medical Attention
Very rarely, this medication can cause eye problems. Serious eye problems include:
- A sudden decrease in vision (acute myopia) with or without eye pain and/or
- A blockage of fluid in the eye causing increased pressure in the eye (glaucoma)
You need to be seen by a physician right away if you have a loss in vision and/or eye pain.
Monitoring and Special Considerations
- Blood levels are not routinely required
- Your doctor may monitor kidney function and electrolytes periodically
- Starting with a low dose and increasing slowly can help reduce side effects
Frequently Asked Questions
Q: How long does it take to work?
A: Topiramate is usually started at a low dose and increased gradually. It may take several weeks to reach the target dose and see the full effect on seizure control.
Q: What if I miss a dose?
A: Give it as soon as you remember. If it is less than 2 hours until the next dosage time, give half of the missed dose right away, and make up the other half missed dose over the next 12 hours. Do not give a double dose. If you miss more than one dose in the same day, check with your doctor. If your child vomits within 30 minutes, give another dose now. Otherwise, wait until the next scheduled dose.
Q: Can topiramate affect my mood or behavior?
A: Yes. Some people may experience mood changes, including depression or anxiety. Report any concerning changes to your healthcare provider promptly.
Q: Will this medication affect my weight?
A: Topiramate commonly causes appetite loss and weight loss. Your doctor will monitor your weight regularly.
Q: Can I take topiramate during pregnancy or breastfeeding?
A: Topiramate can increase the risk of birth defects and should be discussed carefully with your doctor if you are planning pregnancy. Always discuss risks and benefits with your healthcare team.
Q: What about the tingling feeling in my hands and feet?
A: This is a common side effect (paresthesias) that often improves over time. Let your doctor know if it becomes bothersome.
Q: How do I know if topiramate is working?
A: Track your seizures and any side effects in a simple log. Discuss changes with your healthcare provider to adjust dosing if needed. Remember that it may take time to reach the full therapeutic dose.
All of the possible uses, cautions, side effects, or interactions of this drug are not covered in this handout. If you want more information about this medication, ask your child’s doctor, pharmacist, or nurse. This information handout does not pertain to pregnancy or breastfeeding—talk to your doctor if this is a concern.
This information is for educational purposes only and does not replace medical advice. Always consult your healthcare provider about medications and treatment decisions.